Total hip arthroplasty: SuperPath or ABMS?

Total hip arthroplasty is one of the great medical revolutions of the 20th century, enabling millions of patients to return to normal walking. With the continuous development of medicine, alongside improvements in prosthetic materials, new surgical approaches have also been explored with the aim of achieving easier access to the hip joint, minimizing invasiveness, avoiding muscle detachment, and thereby promoting the fastest possible recovery for the patient.

Initially, the hip joint was accessed via a posterior approach, and later through a minimally invasive posterior approach. These approaches were very popular in the past as they provided easy exposure of the hip joint; however, their drawbacks included the transection of the short external rotators and opening of the posterior capsule, which resulted in posterior weakness and a risk of dislocation when performing movements such as squatting or crossing legs. Consequently, postoperative ambulation was also delayed due to patient pain and drainage restrictions. Between 2013 and 2018, I performed approximately 2,000 joint replacement surgeries using this approach.

In recent years, attention has shifted toward alternative surgical approaches such as the SuperPath, ABMS (Rottinger), and Direct Anterior Approach (DAA), which offer the advantages of preserving the fascia, muscles, and joint capsule, thereby reducing patient pain and accelerating recovery. I will focus on two main approaches, ABMS and SuperPath, as they are the ones I frequently use.

In 2019, I completed a clinical fellowship as a resident at Beaujon and Bichat Hospitals in Paris, as well as Paris Diderot University (Paris VII). In the Department of Orthopedic Surgery and Traumatology, I was introduced to the ABMS approach. As major hospitals affiliated with the Assistance Publique - Hôpitaux de Paris (AP-HP), Bichat and Beaujon Hospitals receive a high volume of patients with femoral neck fractures or hip pathologies, which allowed me to perform this technique on a weekly basis—averaging 3 to 5 patients per week over the course of a year. ABMS is a minimally invasive technique utilizing an anterolateral interval, opening the anterior capsule, and maximally preserving the surrounding muscle and tendon groups to facilitate rapid patient recovery. Returning to Vietnam in 2020, I was very keen to apply this approach; however, due to various objective reasons and a lack of specialized instruments, I was only able to implement it recently.

I first became acquainted with the SuperPath approach in 2022 during a workshop held at Viet Duc Friendship Hospital, where I served as both an interpreter and assisting surgeon alongside a British expert. This approach utilizes a small superior incision without muscle detachment and opens the superior capsule. After completing the arthroplasty, it allows for near-complete repair of the superior capsule, thereby enhancing stability and proprioception (spatial awareness) of the artificial hip joint. From 2023 to the present, the majority of my hip replacement patients have been treated using this method.

Figure: The SuperPath approach using a cosmetic subcuticular suture and postoperative surgical tissue adhesive, with no wound drain and no need for dressing changes or suture removal. The patient returned at 10 days postoperatively, walking without an assistive frame and presenting with a neat, minimal scar.

Clearly, both surgical approaches are excellent, so how do we select the appropriate approach for each individual patient?

Based on my personal experience, for primary total hip arthroplasty without significant deformity, or for patients with femoral neck fractures undergoing hemiarthroplasty (replacement of the femoral head only), the SuperPath approach offers more advantages because it allows for nearly complete repair of the superior capsule. Conversely, in cases with severe deformity, the ABMS approach provides direct visualization of the acetabulum (which is very difficult to achieve with the SuperPath approach in the presence of significant limb shortening), offering greater advantages and ease during the arthroplasty procedure.

There is NO single absolute best surgical approach, only the most suitable approach for each specific case. This matter requires discussion and consensus between the surgeon and the patient prior to surgery.